Provider Demographics
NPI:1285855981
Name:CLEM, REBECCA DAWN (MSN, APRN, FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DAWN
Last Name:CLEM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1291
Mailing Address - Country:US
Mailing Address - Phone:865-584-2146
Mailing Address - Fax:865-584-9660
Practice Address - Street 1:1300 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1291
Practice Address - Country:US
Practice Address - Phone:865-584-2146
Practice Address - Fax:865-584-9660
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507356Medicaid